Assess Pain and Patients’ Perceptions of Pain Management in Poststernotomy Cardiac Surgery in Selected Hospital Settings of Punjab, With a View to Develop “Self-Assessment Sternal Precaution Algorithm”

Abstract

Background: Chronic poststernotomy pain is a well-recognized problem. Cardiac surgical patients are often rapidly recovered from anesthesia. The lower levels of sedation given to accelerate this process lead to higher rates of recall in intensive care particularly memories of pain. Method: In a prospective manner a cohort of 200 consecutive patients were evaluated for chronic poststernotomy pain one year after surgery. Participants were identified during the postoperative period by nonprobability purposive sampling method. Generally on the day of transfer to the cardiothoracic step-down ward. The structured interview was conducted before patient is transferred to the ward by using the tool. A prospective analysis of pain was done after 12 months of surgery. Result: The result revealed that after surgery higher 59.50% patients were having mild pain over the surgical site, 38% patients were having moderate pain, 2% patients were having severe pain over the surgical site and it was observed that the pain intensity at none was 0%. The mean of pain intensity at the time of data collection was 3.495 and it was 34.95%. Standard deviation of pain at the time of data collection was 1.23597 and its variance was 1.52761. The anterior regions of body that hurts the most were right anterior and posterior triangles of neck 29%, left anterior and posterior triangles of neck 37%, right supra clavicular region 20%, left supra clavicular region 23%, right clavicular region 12%, left clavicular region 15.5%, right infra clavicular region 30%, left infra clavicular region 37%, supra sternal region 9%, upper sternal region 54%, lower sternal region 22%, right mammary region 16%, left mammary region 52%, right infra mammary region 7%, left infra mammary region 33.5%, infra sternal subcostal angle 7%, left costal margin 12.5% and right costal margin 1.5%. The posterior regions of body that hurts most Cervical region 56.7%, right supra scapular region 4.5%, left supra scapular region 10%, right scapular region 5.50%, left scapular region 10%, inter scapular region 26.5%, right infra scapular region 0.50%, left infra scapular region 3.5% and thoracic vertebral region (T9-T12) 4.5%. The lateral regions of body that hurts most- left shoulder acromial region 4.5% and right shoulder acromial region 2%. The sensory and affective the higher 22% of patients perceived it as tiring-exhausting at mild level. Most of times were 54.5% pain was associated with physiotherapy, 52% with coughing, 50% moving self, 36% when moved by nurse. Pain interfered with patient’s behavior with general activity partially interfered were 77%, with mood partially interfered were 39%, with sleep partially interfered were 61% and with relation with others partially interfered were 55.5%. The regions that hurts most were higher upper sternal region 54%, left mammary region 52%, left anterior and posterior triangles of neck 37%, left infra clavicular region 37%, cervical region 56.7%. The result shown that higher frequency 52 was of 50% pain relief and patients perception of pain management, had to wait for pain killer higher was some of times were 46%, refused pain killer higher was never were 88.5%, felt comfortable higher was some of times were 75.5% and level of pain experience acceptable higher was some of times were 58%. Conclusions: This prospective study shows that sensory pain description was as higher as sharp and affective component of pain shown as higher as tiring-exhausting sensation and complication reported on surgical site after 12 months of post sternotomy surgery 9.28% patients were having numbness on surgical site, 3.8% patients were having tenderness and pulling sensation, tightness was perceived by 3.27% of patients, 1.09% were having mediastinitis and 1.09% patients reported sternal closure wire pricking. Pain after sternotomy was associated with BMI, type of cardiac surgery, number of time under gone cardiac surgery, type of sternotomy and type of analgesics given.